Collaborative breast cancer treatment

Every person diagnosed with breast cancer should become the central focus of a team of medical and allied health experts who meet regularly to discuss the best plan for them – on this point breast cancer experts agree. So why isn’t this happening?

This collaborative approach to breast cancer care is called “multidisciplinary care”. Evidence has suggested this team approach, in which healthcare professionals together consider all treatment options and develop an individual treatment plan for each patient, is now best practice and has been shown to reduce mortality and improve quality of life for the patient.

“It’s unacceptable in this day and age that a woman is not instantly offered access to a multidisciplinary team,” says Christobel Saunders, professor of oncology at the University of Western Australia and a member of the Breast Cancer Network Australia board. “While breast cancer is doing better than other cancers when it comes to accessing multidisciplinary care, it would not be offered to anywhere near 100 per cent of those women who have the disease.”

How it works

Multidisciplinary care occurs when all relevant clinicians work together in a coordinated way to care for a person with breast cancer. A team would most likely include a breast surgeon, who would probably act as the team leader, a breastcare nurse, oncologists (radiation and medical) and the woman’s GP. Ideally this team would meet fortnightly to discuss a list of their shared patients.

Melbourne breast surgeon Dr Suzanne Neil, considered a pioneer in multidisciplinary care in private practice in Australia, says that in recent years the teams have become broader to better meet individual patients’ needs.

“We know it’s important to meet a patient’s psychosocial needs as well as treating the disease, so, depending on the patient, a team could include allied healthcare specialists such as a psychologist, an occupational therapist or a physiotherapist,” Neil says.

“The benefits of this approach are many. It certainly relieves some of the stress for patients because they don’t need to negotiate a confusing medical process alone at such a difficult time. They can have some peace of mind that a team of health specialists, who know each other and are in constant communication, are working together and collaborating on a plan that is tailored just for them.

“And from a professional point of view it keeps specialists and practitioners up to date with what’s happening in our industry.”

Glaring gaps

While the Federal Government’s Cancer Australia agency recognises the multidisciplinary approach is best practice, a recent national audit has highlighted glaring gaps in its availability across the country.

Two-thirds of hospitals surveyed did not have a multidisciplinary team across five core cancer types, including breast cancer. Of those with a team, one-third had not informed their patients their cases would be discussed by a team and 25 per cent did not have a teamrecommended treatment plan recorded in the patients’ files.

Cancer Australia’s CEO Helen Zorbas, who was also an author of the audit review, acknowledges that rolling out this style of care has had some difficulties.

“The delivery of multidisciplinary cancer care in Australia can be challenging given rural and urban differences in population density and resource availability, and the mix of public and private services,” she says.

“Despite these challenges, the number of multidisciplinary teams andcancer patients benefiting from multidisciplinary team discussion have continued to increase across Australia over the past decade.”

Neil says the public system is doing it better than the private at this stage – and this is probably largely to do with financial remuneration.

“In the public health system, specialists and allied health workers are being paid to attend the multidisciplinary care meetings – but this is often not the case for private specialists,” she says. “This can make it a less attractive option for some.”

Saunders says while the government introduced Medicare item numbers for these meetings six years ago to counter the private sector’s reluctance to take part in teams, it has “not worked as well as it should”.

“Unsurprisingly, its uptake in rural and remote areas is also more limited because cancer services, the specialists and allied health professionals tend to be concentrated in cities and larger regional centres,” she says.

Expert tips

Do your reasearch: If you’re diagnosed with breast cancer, contact an organisation such as the Breast Cancer Network Australia to get information on how to start the process.

Make sure your GP is in the loop: Your GP can relay information to you and provide insights to your cancer-care team. They will ideally be a team member.
Does your surgeon have a breast-cancer nurse? If not, Professor Christobel Saunders recommends looking for another surgeon. Breast-care nurses provide important information and support.

“My care has been gold standard”

Erin Lewis Fitzgerald, 34, was diagnosed with breast cancer in June. She is a multidisciplinary care patient with Dr Suzanne Neil. She had a lumpectomy and lymph nodes removed and is undergoing radiation.

“I was diagnosed when my husband and I decided to start a family. Suzanne immediately put a fertility specialist on my team and I now have embryos on ice.

“My team also includes a breast cancer surgeon and medical and radiation oncologists. They are in communication all the time. My surgeon and her nurse organise all my appointments for me.

“Being diagnosed with breast cancer is stressful, but my care has been gold-class standard.”

Check out our breast cancer zone for everything from how to perform a breast check to our post-masectomy workout.